|
HC WHFO ADJ MP FLEX CNTRL + IP
|
Facility
|
OP
|
$445.00
|
|
| Hospital Charge Code |
903203860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$145.74 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Adventist Health Commercial |
$182.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$244.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$333.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$258.86
|
| Rate for Payer: Blue Shield of California Commercial |
$356.89
|
| Rate for Payer: Blue Shield of California EPN |
$224.28
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Cigna of CA HMO |
$311.50
|
| Rate for Payer: Cigna of CA PPO |
$311.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$378.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$378.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$161.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$262.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$311.50
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$222.50
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Riverside University Health System MISP |
$178.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$267.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.01
|
| Rate for Payer: United Healthcare All Other HMO |
$162.56
|
| Rate for Payer: United Healthcare HMO Rider |
$159.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$378.25
|
| Rate for Payer: Vantage Medical Group Senior |
$378.25
|
|
|
HC WHFO ADJ MP FLEX CNTRL + IP
|
Facility
|
IP
|
$445.00
|
|
| Hospital Charge Code |
903203860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Blue Shield of California Commercial |
$356.89
|
| Rate for Payer: Blue Shield of California EPN |
$224.28
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Cigna of CA HMO |
$311.50
|
| Rate for Payer: Cigna of CA PPO |
$311.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$262.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.01
|
| Rate for Payer: United Healthcare All Other HMO |
$162.56
|
| Rate for Payer: United Healthcare HMO Rider |
$159.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.74
|
|
|
HC WHFO COCK UP SPLINT
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
915363908
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.98 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Dignity Health Medi-Cal |
$238.85
|
| Rate for Payer: Adventist Health Commercial |
$115.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.46
|
| Rate for Payer: Blue Shield of California Commercial |
$225.36
|
| Rate for Payer: Blue Shield of California EPN |
$141.62
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Central Health Plan Commercial |
$224.80
|
| Rate for Payer: Cigna of CA HMO |
$196.70
|
| Rate for Payer: Cigna of CA PPO |
$196.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Senior |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.85
|
| Rate for Payer: Global Benefits Group Commercial |
$168.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$178.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$196.70
|
| Rate for Payer: Multiplan Commercial |
$210.75
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.85
|
| Rate for Payer: Riverside University Health System MISP |
$112.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.46
|
| Rate for Payer: United Healthcare All Other HMO |
$102.65
|
| Rate for Payer: United Healthcare HMO Rider |
$100.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.85
|
| Rate for Payer: Vantage Medical Group Senior |
$238.85
|
|
|
HC WHFO COCK UP SPLINT
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
915363908
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.20 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Adventist Health Commercial |
$56.20
|
| Rate for Payer: Blue Shield of California Commercial |
$225.36
|
| Rate for Payer: Blue Shield of California EPN |
$141.62
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Central Health Plan Commercial |
$224.80
|
| Rate for Payer: Cigna of CA HMO |
$196.70
|
| Rate for Payer: Cigna of CA PPO |
$196.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Senior |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.85
|
| Rate for Payer: Global Benefits Group Commercial |
$168.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$178.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.20
|
| Rate for Payer: Multiplan Commercial |
$210.75
|
| Rate for Payer: Networks By Design Commercial |
$182.65
|
| Rate for Payer: Prime Health Services Commercial |
$238.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.46
|
| Rate for Payer: United Healthcare All Other HMO |
$102.65
|
| Rate for Payer: United Healthcare HMO Rider |
$100.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.03
|
|
|
HC WHFO COCK UP SPLINT
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
905363908
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.20 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Adventist Health Commercial |
$56.20
|
| Rate for Payer: Blue Shield of California Commercial |
$225.36
|
| Rate for Payer: Blue Shield of California EPN |
$141.62
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Central Health Plan Commercial |
$224.80
|
| Rate for Payer: Cigna of CA HMO |
$196.70
|
| Rate for Payer: Cigna of CA PPO |
$196.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Senior |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.85
|
| Rate for Payer: Global Benefits Group Commercial |
$168.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$178.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.20
|
| Rate for Payer: Multiplan Commercial |
$210.75
|
| Rate for Payer: Networks By Design Commercial |
$182.65
|
| Rate for Payer: Prime Health Services Commercial |
$238.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.46
|
| Rate for Payer: United Healthcare All Other HMO |
$102.65
|
| Rate for Payer: United Healthcare HMO Rider |
$100.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.03
|
|
|
HC WHFO COCK UP SPLINT
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
905363908
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.98 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Adventist Health Commercial |
$115.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.46
|
| Rate for Payer: Blue Shield of California Commercial |
$225.36
|
| Rate for Payer: Blue Shield of California EPN |
$141.62
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Cash Price |
$126.45
|
| Rate for Payer: Central Health Plan Commercial |
$224.80
|
| Rate for Payer: Cigna of CA HMO |
$196.70
|
| Rate for Payer: Cigna of CA PPO |
$196.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.40
|
| Rate for Payer: EPIC Health Plan Senior |
$112.40
|
| Rate for Payer: Galaxy Health WC |
$238.85
|
| Rate for Payer: Global Benefits Group Commercial |
$168.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$178.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$196.70
|
| Rate for Payer: Multiplan Commercial |
$210.75
|
| Rate for Payer: Networks By Design Commercial |
$140.50
|
| Rate for Payer: Prime Health Services Commercial |
$238.85
|
| Rate for Payer: Riverside University Health System MISP |
$112.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.46
|
| Rate for Payer: United Healthcare All Other HMO |
$102.65
|
| Rate for Payer: United Healthcare HMO Rider |
$100.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.85
|
| Rate for Payer: Vantage Medical Group Senior |
$238.85
|
|
|
HC WHFO COMB OPPEN W KNUCKLE BNDR
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
903203950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Adventist Health Commercial |
$50.20
|
| Rate for Payer: Blue Shield of California Commercial |
$201.30
|
| Rate for Payer: Blue Shield of California EPN |
$126.50
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Central Health Plan Commercial |
$200.80
|
| Rate for Payer: Cigna of CA HMO |
$175.70
|
| Rate for Payer: Cigna of CA PPO |
$175.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$175.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.40
|
| Rate for Payer: EPIC Health Plan Senior |
$100.40
|
| Rate for Payer: Galaxy Health WC |
$213.35
|
| Rate for Payer: Global Benefits Group Commercial |
$150.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$159.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.20
|
| Rate for Payer: Multiplan Commercial |
$188.25
|
| Rate for Payer: Networks By Design Commercial |
$163.15
|
| Rate for Payer: Prime Health Services Commercial |
$213.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.20
|
| Rate for Payer: United Healthcare All Other HMO |
$91.69
|
| Rate for Payer: United Healthcare HMO Rider |
$89.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.20
|
|
|
HC WHFO COMB OPPEN W KNUCKLE BNDR
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
903203950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.23 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Adventist Health Commercial |
$102.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$213.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.01
|
| Rate for Payer: Blue Shield of California Commercial |
$201.30
|
| Rate for Payer: Blue Shield of California EPN |
$126.50
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Central Health Plan Commercial |
$200.80
|
| Rate for Payer: Cigna of CA HMO |
$175.70
|
| Rate for Payer: Cigna of CA PPO |
$175.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$213.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$213.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$213.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$175.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.40
|
| Rate for Payer: EPIC Health Plan Senior |
$100.40
|
| Rate for Payer: Galaxy Health WC |
$213.35
|
| Rate for Payer: Global Benefits Group Commercial |
$150.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$159.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$175.70
|
| Rate for Payer: Multiplan Commercial |
$188.25
|
| Rate for Payer: Networks By Design Commercial |
$125.50
|
| Rate for Payer: Prime Health Services Commercial |
$213.35
|
| Rate for Payer: Riverside University Health System MISP |
$100.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.20
|
| Rate for Payer: United Healthcare All Other HMO |
$91.69
|
| Rate for Payer: United Healthcare HMO Rider |
$89.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$213.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$213.35
|
| Rate for Payer: Vantage Medical Group Senior |
$213.35
|
|
|
HC WHFO COMB OPPEN W/REVRS KNUCKL
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
903203952
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.91 |
| Max. Negotiated Rate |
$279.19 |
| Rate for Payer: Adventist Health Commercial |
$100.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$207.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$183.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.93
|
| Rate for Payer: Blue Shield of California Commercial |
$195.69
|
| Rate for Payer: Blue Shield of California EPN |
$122.98
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: Cigna of CA HMO |
$170.80
|
| Rate for Payer: Cigna of CA PPO |
$170.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$207.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$207.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Senior |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$170.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$122.00
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
| Rate for Payer: Riverside University Health System MISP |
$97.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$146.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$146.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.57
|
| Rate for Payer: United Healthcare All Other HMO |
$89.13
|
| Rate for Payer: United Healthcare HMO Rider |
$87.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$207.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.40
|
| Rate for Payer: Vantage Medical Group Senior |
$207.40
|
|
|
HC WHFO COMB OPPEN W/REVRS KNUCKL
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
903203952
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Blue Shield of California Commercial |
$195.69
|
| Rate for Payer: Blue Shield of California EPN |
$122.98
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: Cigna of CA HMO |
$170.80
|
| Rate for Payer: Cigna of CA PPO |
$170.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Senior |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.57
|
| Rate for Payer: United Healthcare All Other HMO |
$89.13
|
| Rate for Payer: United Healthcare HMO Rider |
$87.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.91
|
|
|
HC WHFO ELECTRIC POWERED
|
Facility
|
OP
|
$6,604.00
|
|
|
Service Code
|
CPT L3904
|
| Hospital Charge Code |
905353904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,162.81 |
| Max. Negotiated Rate |
$5,943.60 |
| Rate for Payer: Adventist Health Commercial |
$2,707.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,613.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,632.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,953.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,841.55
|
| Rate for Payer: Blue Shield of California Commercial |
$5,296.41
|
| Rate for Payer: Blue Shield of California EPN |
$3,328.42
|
| Rate for Payer: Cash Price |
$2,971.80
|
| Rate for Payer: Cash Price |
$2,971.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,283.20
|
| Rate for Payer: Cigna of CA HMO |
$4,622.80
|
| Rate for Payer: Cigna of CA PPO |
$4,622.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,613.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,613.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,613.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,622.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,641.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,641.60
|
| Rate for Payer: Galaxy Health WC |
$5,613.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,962.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,943.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,525.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,193.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,894.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,896.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,707.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,622.80
|
| Rate for Payer: Multiplan Commercial |
$4,953.00
|
| Rate for Payer: Networks By Design Commercial |
$3,302.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,613.40
|
| Rate for Payer: Riverside University Health System MISP |
$2,641.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,962.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,962.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,478.48
|
| Rate for Payer: United Healthcare All Other HMO |
$2,412.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2,360.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,162.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,613.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,613.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5,613.40
|
|
|
HC WHFO ELECTRIC POWERED
|
Facility
|
IP
|
$6,604.00
|
|
|
Service Code
|
CPT L3904
|
| Hospital Charge Code |
915353904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,320.80 |
| Max. Negotiated Rate |
$5,943.60 |
| Rate for Payer: Adventist Health Commercial |
$1,320.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,296.41
|
| Rate for Payer: Blue Shield of California EPN |
$3,328.42
|
| Rate for Payer: Cash Price |
$2,971.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,283.20
|
| Rate for Payer: Cigna of CA HMO |
$4,622.80
|
| Rate for Payer: Cigna of CA PPO |
$4,622.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,622.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,641.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,641.60
|
| Rate for Payer: Galaxy Health WC |
$5,613.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,962.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,943.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,193.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,896.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,320.80
|
| Rate for Payer: Multiplan Commercial |
$4,953.00
|
| Rate for Payer: Networks By Design Commercial |
$4,292.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,613.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,478.48
|
| Rate for Payer: United Healthcare All Other HMO |
$2,412.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2,360.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,162.81
|
|
|
HC WHFO ELECTRIC POWERED
|
Facility
|
OP
|
$6,604.00
|
|
|
Service Code
|
CPT L3904
|
| Hospital Charge Code |
915353904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,162.81 |
| Max. Negotiated Rate |
$5,943.60 |
| Rate for Payer: Adventist Health Commercial |
$2,707.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,613.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,632.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,953.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,841.55
|
| Rate for Payer: Blue Shield of California Commercial |
$5,296.41
|
| Rate for Payer: Blue Shield of California EPN |
$3,328.42
|
| Rate for Payer: Cash Price |
$2,971.80
|
| Rate for Payer: Cash Price |
$2,971.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,283.20
|
| Rate for Payer: Cigna of CA HMO |
$4,622.80
|
| Rate for Payer: Cigna of CA PPO |
$4,622.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,613.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,613.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,613.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,622.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,641.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,641.60
|
| Rate for Payer: Galaxy Health WC |
$5,613.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,962.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,943.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,525.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,193.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,894.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,896.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,707.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,622.80
|
| Rate for Payer: Multiplan Commercial |
$4,953.00
|
| Rate for Payer: Networks By Design Commercial |
$3,302.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,613.40
|
| Rate for Payer: Riverside University Health System MISP |
$2,641.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,962.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,962.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,478.48
|
| Rate for Payer: United Healthcare All Other HMO |
$2,412.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2,360.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,162.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,613.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,613.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5,613.40
|
|
|
HC WHFO ELECTRIC POWERED
|
Facility
|
IP
|
$6,604.00
|
|
|
Service Code
|
CPT L3904
|
| Hospital Charge Code |
905353904
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,320.80 |
| Max. Negotiated Rate |
$5,943.60 |
| Rate for Payer: Adventist Health Commercial |
$1,320.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,296.41
|
| Rate for Payer: Blue Shield of California EPN |
$3,328.42
|
| Rate for Payer: Cash Price |
$2,971.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,283.20
|
| Rate for Payer: Cigna of CA HMO |
$4,622.80
|
| Rate for Payer: Cigna of CA PPO |
$4,622.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,622.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,641.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,641.60
|
| Rate for Payer: Galaxy Health WC |
$5,613.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,962.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,943.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,193.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,896.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,320.80
|
| Rate for Payer: Multiplan Commercial |
$4,953.00
|
| Rate for Payer: Networks By Design Commercial |
$4,292.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,613.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,478.48
|
| Rate for Payer: United Healthcare All Other HMO |
$2,412.44
|
| Rate for Payer: United Healthcare HMO Rider |
$2,360.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,162.81
|
|
|
HC WHFO FINGER EXTENSION
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905363928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.42 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Adventist Health Commercial |
$64.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.33
|
| Rate for Payer: Blue Shield of California Commercial |
$125.91
|
| Rate for Payer: Blue Shield of California EPN |
$79.13
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$109.90
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Riverside University Health System MISP |
$62.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC WHFO FINGER EXTENSION
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905363928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Blue Shield of California Commercial |
$125.91
|
| Rate for Payer: Blue Shield of California EPN |
$79.13
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.40
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
|
|
HC WHFO FINGER EXTENSION
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Blue Shield of California Commercial |
$125.91
|
| Rate for Payer: Blue Shield of California EPN |
$79.13
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.40
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
|
|
HC WHFO FINGER EXTENSION
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353928
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.42 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Adventist Health Commercial |
$64.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.33
|
| Rate for Payer: Blue Shield of California Commercial |
$125.91
|
| Rate for Payer: Blue Shield of California EPN |
$79.13
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$109.90
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Riverside University Health System MISP |
$62.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC WHFO FINGER EXT W/CLOCK SPRIN
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
901309105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Blue Shield of California Commercial |
$113.08
|
| Rate for Payer: Blue Shield of California EPN |
$71.06
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Central Health Plan Commercial |
$112.80
|
| Rate for Payer: Cigna of CA HMO |
$98.70
|
| Rate for Payer: Cigna of CA PPO |
$98.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.40
|
| Rate for Payer: EPIC Health Plan Senior |
$56.40
|
| Rate for Payer: Galaxy Health WC |
$119.85
|
| Rate for Payer: Global Benefits Group Commercial |
$84.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.20
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: Networks By Design Commercial |
$91.65
|
| Rate for Payer: Prime Health Services Commercial |
$119.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.92
|
| Rate for Payer: United Healthcare All Other HMO |
$51.51
|
| Rate for Payer: United Healthcare HMO Rider |
$50.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.18
|
|
|
HC WHFO FINGER EXT W/CLOCK SPRIN
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
901309105
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.18 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Adventist Health Commercial |
$57.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.02
|
| Rate for Payer: Blue Shield of California Commercial |
$113.08
|
| Rate for Payer: Blue Shield of California EPN |
$71.06
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Central Health Plan Commercial |
$112.80
|
| Rate for Payer: Cigna of CA HMO |
$98.70
|
| Rate for Payer: Cigna of CA PPO |
$98.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$119.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$119.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.40
|
| Rate for Payer: EPIC Health Plan Senior |
$56.40
|
| Rate for Payer: Galaxy Health WC |
$119.85
|
| Rate for Payer: Global Benefits Group Commercial |
$84.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$98.70
|
| Rate for Payer: Multiplan Commercial |
$105.75
|
| Rate for Payer: Networks By Design Commercial |
$70.50
|
| Rate for Payer: Prime Health Services Commercial |
$119.85
|
| Rate for Payer: Riverside University Health System MISP |
$56.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.92
|
| Rate for Payer: United Healthcare All Other HMO |
$51.51
|
| Rate for Payer: United Healthcare HMO Rider |
$50.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.85
|
| Rate for Payer: Vantage Medical Group Senior |
$119.85
|
|
|
HC WHFO FINGER KNUCKLE BENDER
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353948
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Blue Shield of California Commercial |
$43.31
|
| Rate for Payer: Blue Shield of California EPN |
$27.22
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$37.80
|
| Rate for Payer: Cigna of CA PPO |
$37.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.27
|
| Rate for Payer: United Healthcare All Other HMO |
$19.73
|
| Rate for Payer: United Healthcare HMO Rider |
$19.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.68
|
|
|
HC WHFO FINGER KNUCKLE BENDER
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905353948
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Adventist Health Commercial |
$22.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.41
|
| Rate for Payer: Blue Shield of California Commercial |
$43.31
|
| Rate for Payer: Blue Shield of California EPN |
$27.22
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Central Health Plan Commercial |
$43.20
|
| Rate for Payer: Cigna of CA HMO |
$37.80
|
| Rate for Payer: Cigna of CA PPO |
$37.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.60
|
| Rate for Payer: EPIC Health Plan Senior |
$21.60
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: Networks By Design Commercial |
$27.00
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Riverside University Health System MISP |
$21.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.27
|
| Rate for Payer: United Healthcare All Other HMO |
$19.73
|
| Rate for Payer: United Healthcare HMO Rider |
$19.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.90
|
| Rate for Payer: Vantage Medical Group Senior |
$45.90
|
|
|
HC WHFO FING EXT WRIST SUPPORT
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Blue Shield of California Commercial |
$449.12
|
| Rate for Payer: Blue Shield of California EPN |
$282.24
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Central Health Plan Commercial |
$448.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$504.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$355.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$330.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
|
|
HC WHFO FING EXT WRIST SUPPORT
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300801
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$420.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$325.75
|
| Rate for Payer: Blue Shield of California Commercial |
$449.12
|
| Rate for Payer: Blue Shield of California EPN |
$282.24
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Central Health Plan Commercial |
$448.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$476.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$476.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$476.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$504.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$252.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$355.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$279.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$330.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$392.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$280.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: Riverside University Health System MISP |
$224.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$476.00
|
| Rate for Payer: Vantage Medical Group Senior |
$476.00
|
|
|
HC WHFO FLEXION GLOVE
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT L3912
|
| Hospital Charge Code |
915353912
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Blue Shield of California Commercial |
$170.02
|
| Rate for Payer: Blue Shield of California EPN |
$106.85
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$134.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$137.80
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
|
